Sunday, August 5, 2012

Progress Report

Hmmm. How quickly I move from "No diet talk" to "All diet talk, all the time." Guess there's not much more going on at the moment.

I'm spending these days lately re-learning how to eat. Not really that, exactly; I'm not starting from scratch, but rather I'm having to learn a fundamentally new way of eating. This is kind of like remodeling one's house while living in it and ending up in a house that really doesn't resemble the old one at all. I've got 50 years' experience stuffing food in my mouth, and I'm having to radically change ALL of these deeply-ingrained behaviors.

This happens in stages. We progress after surgery in 10-day increments from clear liquids to opaque liquids ("full" liquids, they call them) to pureed / mushy foods. A month after surgery we are back to regular foods, but we are introducing them back into a changed landscape. The long and short of it, as I've said a few times here, is that we can eat very little in a sitting now, and that changes everything, really.

We are told to emphasize protein, which is hard in the early stages when one can't eat meat. We rely on protein shakes and drinks and powders, and there is such a dizzying variety that there must be some trial and error. I bought some "unflavored" whey protein, which I thought I might just mix with any flavored drink, but it doesn't really work out that way. "Unflavored," it turns out, doesn't mean "no flavor;" it means "flavored so as to be incompatible with most other flavors." After a couple servings that stuff hasn't gotten much exercise. Following the recommendations of others, I bought some pre-mixed shakes that are really quite good (the chocolate tastes like liquid pudding), and there are a couple flavored powders I've tried that are quite passable. One wants to make friends here, as some form of protein supplement seems to be the lifelong companion of most bariatric patients.

These early liquid-only phases did not bring me firmly up against my new small-meal limitations. This is because the liquids don't sit in the stomach; they pass quickly through and into the intestine, which leaves room for more very quickly. So I'm able to consume more liquid in a sitting--albeit at a reduced pace--than my new stomach will hold, which in turn cheats my brain into thinking my capacity is greater than it is. I know it intellectually, of course--meals of 1.5-2 oz. in the beginning. But I'm only starting to grasp that this is what a MEAL will be. For the last 50 years 2 oz. wouldn't even begin to rise to the level of a snack.

Even so, I had a couple incidents in the liquid phases that have helped show me the light in a fairly visceral (sorry!) way: I mentioned my jello epiphany of a week ago, when I blithely ate a sugar free jello cup and realized that it was sitting in my esophagus because *surprise!* there's not ROOM for 3.25 oz. in there just now! Because jello qualifies as a "liquid," my digestive system was rather tolerant of this excess; but I understand that the same quantity of solid food would have brought a stronger (and less pleasant) reaction--a serious nausea or a return of the goods, as it were. I got another sense of this when drinking a protein shake a couple days ago. The pre-mixed ones I'm drinking (by Premier, in chocolate flavor) are quite thin, almost like chocolate milk, and they go down quite like a liquid (despite being 11 oz., I'm able to drink a whole one in 15 minutes or so). But when I used some Matrix Cookies and Cream powder mixed with milk, I find the texture considerably thicker, and I very quickly feel full with just a couple sips of this. I initially drank, say, 8 oz. in a short-ish time (kind of sipping unconsciously) and found my whole system vaguely unhappy--vaguely achey and slightly nauseous, none of it very strong but present just the same. It struck me that this powdered stuff may not be passing through like the Premier, and I may have to drink this stuff veeeery slowly.

As I say, this is a valuable lesson, because the pureed / mushy foods I started today will bring me up against these limits straight away: nothing that qualifies as actual food gets the free pass treatment. The pyloric valve at the bottom of the stomach, as I understand it, makes a determination of what needs digesting and what can pass without processing. Solid food gets held up for digestion, and we will come to rely on this feeling of "fullness" to be our new trigger to eat or stop eating.

I officially started the mushy / pureed food phase today (a day early), initiating the milestone event with a piece of quiche and a bite or two of macaroni and cheese. The quiche was not pureed enough, I'm sure, but it went down without too much trauma. But the interesting thing is how little I ate and how convincing was my sensation that it was still too much. I wasn't sick, but I was uncomfortable and had a vague feeling of overfullness. It passed in about 15 minutes, but I feel pretty sure that my five bites were two too many.

There's definitely a learning curve.

I'm grateful that my learning curve so far has involved very little discomfort and no sickness or difficulty apart from flagging energy--which is to be expected when one is eating little or nothing. And actually even this low energy state is pretty handily offset by my needing markedly less energy to DO things; the lighter I get the easier everything becomes. Add in that my body will adjust over time and I'm beginning to consume small quantities of real food, and I expect my world to change in really substantial ways. I've lost about 30 lbs. so far, not quite a third of what I hope to lose, and the changes are pretty noticeable already. I've been in this current weight range a number of times in the last decade with diet after diet, so this is not really new territory for me, however welcome. I started at about 280 and am now down to 250 or so (no scale in KY, so I'm not exactly sure of my progress until I get home Wednesday). When I get below 240 I'm in pretty rare territory for me, and below 200 is a place I've not been since seventh grade. When I met Susan 14 years ago I was running a lot and down to about 210, and I remember an aviation physical at the time showing 203. This is the skinniest I've ever been in my adult life, and it lasted about 25 seconds. And even then I qualified as obese, even if I looked fantastic to the friends who were used to seeing a 250 lb. me. So the prospect of being a normal, healthy body weight is like a dream to me.

I'll post some progress pictures in a week or so on my one month surgery anniversary (often called the "surgiversary."